Transarterial chemoembolization in hepatocellular carcinoma treatment: Barcelona clinic liver cancer staging system
Transarterial chemoembolization in hepatocellular carcinoma treatment: Barcelona clinic liver cancer staging system
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DOI：
10.3748/wjg.v21.i36.10327
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发表时间：
2015-09-28
影响因子：
4.3
通讯作者：
Kim, Jin Hyoung
中科院分区：
文献类型：
--
作者：
Han, Kichang;Kim, Jin Hyoung
肝细胞癌（HCC）是主要发生在肝硬化患者中的第五大常见癌症，需要分期系统来设计治疗方案。巴塞罗那临床肝癌分期系统（BCLC）是最常用的HCC管理指南。对于BCLC B期（中度HCC），经动脉化疗栓塞（TACE）是标准治疗。许多研究支持在早期和晚期HCC患者中使用TACE。对于BCLC 0期（极早期HCC），TACE可能是不适合射频消融（RFA）或肝切除术的患者的替代方案。在BCLC A期患者中，TACE联合RFA比单独RFA提供更好的局部肿瘤控制。TACE可作为等待肝移植患者的过渡治疗。对于BCLC B患者，与支持性治疗方案相比，TACE可提供生存获益。然而，由于该阶段患者人群的实质异质性，需要更好的患者分层系统来选择TACE的最佳候选人。索拉非尼代表了BCLC C期HCC患者的一线治疗。索拉非尼联合TACE在延迟肿瘤进展方面显示出明显的效果。此外，肝动脉化疗栓塞联合放疗在肝癌伴门静脉血栓形成患者中获得了更好的生存率。综合考虑这些观察结果，TACE作为HCC各阶段的单独或联合治疗在HCC治疗中显然具有关键作用。HCC患者应采用多样化的治疗方式，并应制定更好的患者分层系统，以选择最佳TACE候选人。
Hepatocellular carcinoma (HCC), the fifth most common cancer that predominantly occurs in liver cirrhosis patients, requires staging systems to design treatments. The barcelona clinic liver cancer staging system (BCLC) is the most commonly used HCC management guideline. For BCLC stage B (intermediate HCC), transarterial chemoembolization (TACE) is the standard treatment. Many studies support the use of TACE in early and advanced HCC patients. For BCLC stage 0 (very early HCC), TACE could be an alternative for patients unsuitable for radiofrequency ablation (RFA) or hepatic resection. In patients with BCLC stage A, TACE plus RFA provides better local tumor control than RFA alone. TACE can serve as bridge therapy for patients awaiting liver transplantation. For patients with BCLC B, TACE provides survival benefits compared with supportive care options. However, because of the substantial heterogeneity in the patient population with this stage, a better patient stratification system is needed to select the best candidates for TACE. Sorafenib represents the first line treatment in patients with BCLC C stage HCC. Sorafenib plus TACE has shown a demonstrable effect in delaying tumor progression. Additionally, TACE plus radiotherapy has yielded better survival in patients with HCC and portal venous thrombosis. Considering these observations together, TACE clearly has a critical role in the treatment of HCC as a stand-alone or combination therapy in each stage of HCC. Diverse treatment modalities should be used for patients with HCC and a better patient stratification system should be developed to select the best candidates for TACE.